Summary: A combination of transcranial magnetic stimulation and peripheral nerve stimulation may help in the rehabilitation of people with spinal cord injury.

Source: Helsinki University Hospital.

Conducted at the BioMag laboratory at the Helsinki University Hospital, a new patient study could open a new opportunity to rehabilitate patients with spinal cord damage.

Dr Anastasia Shulga, a medical doctor specialising in neurology, led a study in which two patients with spinal cord injuries received a form of treatment that combined transcranial magnetic stimulation with simultaneous peripheral nerve stimulation given repeatedly for nearly six months. This was the first time that attempts were made to rehabilitate patients paralysed as a result of a spinal cord injury through long-term stimulation treatment of this type.

Both patients who participated in the study had spinal cord injuries caused by trauma. One patient was paraplegic, paralysed from the knees down, and the other was tetraplegic, with some voluntary movement of the hands but no capacity to grasp. Both patients had been injured more than two years ago and had received conventional rehabilitation treatments throughout their recovery, and continued to do so during the stimulation treatment.

After approximately six months of the stimulation treatment, the tetraplegic patient could grasp an object. NeuroscienceNews.com image is credited to Anastasia Shulga.

The movement restored during the treatment was still present a month after the stimulation treatment had ended. One of the patients is participating in a further study in which stimulation is given more extensively and for an even longer period.

Dr. Jyrki Mäkelä, head of the BioMag laboratory, points out that rehabilitation of patients with chronic spinal cord injuries is highly challenging, and new treatment methods are sorely needed:

“This is a case study with two patients only, but we think the results are promising. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.”

About this neurology research article

The BioMag research laboratory is operated jointly by the University of Helsinki, the Helsinki University Hospital and Aalto University in conjunction with the HUS Medical Imaging Center.

Emerging therapeutic strategies for spinal cord injury aim at sparing or restoring at least part of the corticospinal tract at the acute stage. Hence, approaches that strengthen the weak connections that are spared or restored are crucial. Transient plastic changes in the human corticospinal tract can be induced through paired associative stimulation, a noninvasive technique in which transcranial magnetic brain stimulation is synchronized with electrical peripheral nerve stimulation. A single paired associative stimulation session can induce transient plasticity in spinal cord injury patients. It is not known whether paired associative stimulation can strengthen neuronal connections persistently and have therapeutic effects that are clinically relevant. We recruited two patients with motor-incomplete chronic (one para- and one tetraplegic) spinal cord injuries. The patients received paired associative stimulation for 20–24 weeks. The paraplegic patient, previously paralyzed below the knee level, regained plantarflexion and dorsiflexion of the ankles of both legs. The tetraplegic patient regained grasping ability. The newly acquired voluntary movements could be performed by the patients in the absence of stimulation and for at least 1 month after the last stimulation session. In this unblinded proof-of-principle demonstration in two subjects, long-term paired associative stimulation induced persistent and clinically relevant strengthening of neural connections and restored voluntary movement in previously paralyzed muscles. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.